摘要
目的:比较髋关节置换术行静脉全麻和腰-硬膜外麻醉患者的血流动力学和血液流变学指标变化。方法:92例髋关节置换术患者按随机数字表法分为静脉全麻组和腰-硬膜外麻醉组,每组各46例。静脉全麻组行气管内插管后微量泵静脉给予瑞芬太尼(0.1-0.5μg/kg/h)和丙泊酚(4-6mg/h),腰-硬膜外麻醉组行L2-3腰-硬膜外穿刺给药予0.5%左布比卡因2ml。对比两组麻醉前(T0)、麻醉5min(T1)、麻醉30min(T2)及术后5min(T3)、30min(T4)的血流动力学和血液流变学指标以及药物起效、阻滞完成时间和麻醉并发症发生率的差异。结果:两组T0血流动力学及血液流变学指标差异无统计学意义(P>0.05)。腰-硬膜外麻醉组T1、T2、T3、T4时血压(BP)、心率(HR)、血氧饱和度(SPO2)均明显高于静脉全麻组(P<0.05),全血黏度、全血还原黏度、血浆黏度亦明显高于静脉全麻组(P<0.05)。腰-硬膜外麻醉组内各时相的BP、HR、SPO2、全血黏度、全血还原黏度、血浆黏度均无明显差异(P>0.05);而静脉全麻组内各时相上述各指标均存在明显差异(P<0.05),T1-T4均低于T0(P<0.05)。同时,腰-硬膜外麻醉组麻醉起效时间、阻滞完全时间短于静脉全麻组(P<0.05)。两组均未发生药物不良反应和麻醉并发症。结论:髋关节置换术患者采用腰-硬膜外麻醉更合适。
Objective：To compare the changes of hemodynamics and hemorrheology in patients undergoing intravenous general anesthesia and lumbar epidural anesthesia during hip arthroplasty.Method：Ninety-two patients undergoing total hip arthroplasty were divided into intravenous general anesthesia group and lumbar-epidural anesthesia group by random number table.Intravenous general anesthesia group received intravenous administration of remifentanil 0.1-0.5μg/kg/h and propofol 4-6mg/h after tracheal intubation,and L2-3lumbar-epidural puncture with 0.5% bupivacaine left 2ml.The hemodynamics and hemorheological parameters of the two groups before and after anesthesia（T0）,5min（T1）,30min（T2）and 5min（T3）,30min（T4）lag time and the incidence of anesthesia complications were analyzed.Results：There were no significant differences in hemodynamics and hemorheology between the two groups in T0（P〈0.05）.Blood pressure（BP）,heart rate（HR）,the whole blood viscosity,whole blood reduced viscosity and plasma viscosity in lumbar-epidural anesthesia group were significantly higher than those in intravenous anesthesia group on T1,T2,T3,T4（P〈0.05）.There were no significant differences in BP,HR,SPO2,whole blood viscosity,whole blood reduced viscosity and plasma viscosity in the lumbar-epidural anesthesia group on T0-T4（P〈0.05）,but the above indexes in the intravenous anesthesia group were significantlydifferent,indexes on T1-T4 were lower than T0（P〈0.05）.The time of onset of anesthesia was shorter in the group of epidural anesthesia than that in the group of intravenous anesthesia（P〈0.05）,and the difference was significant（P〈0.05）.Adverse drug reactions and anesthetic complications did not occur in either group.Conclusion：Lumbar-epidural anesthesia is more appropriate in patients undergoing hip arthroplasty.
出处
《微循环学杂志》
2016年第4期53-57,共5页
Chinese Journal of Microcirculation
关键词
髋关节置换术
静脉麻醉
腰-硬膜外麻醉
Hip arthroplasty
Intravenous anesthesia
Lumbar-epidural anesthesia
